Sewing Masks — Resilience in the Face of Covid

The phone calls from that night in March linger in my thoughts. At 9:30 p.m., a woman wept in pain, saying her knee was swollen and excruciating. In the background, I heard the patient’s wife trying to comfort her. I thought, I don’t want her to go to the emergency department. I thought, I don’t know if she can bear it at home. Then at 10 p.m., “I don’t feel so good,” a patient murmured. Over 80 years old, she lived with a relative who had advanced dementia. “My head hurts whenever I get up. My nose is stuffy.” I thought Covid. Everything was Covid.

I weighed the risks, decided to advise both patients to treat themselves with Tylenol and see if they improved enough to avoid the emergency department. Two months earlier, I would have said otherwise.

At 5 a.m., a caller pleaded, “My mother is having trouble breathing. She was diagnosed with Covid last week. Her fever hasn’t gone away.” The mother tried to speak, managed two words before gasping for air. “You need to go to the hospital,” I said. “Now.”

These phone discussions occurred during a Friday night on call as a primary care physician at Brigham and Women’s Hospital. During the early months of the pandemic, I had transitioned mostly to remote patient care, interspersed with weekly shifts at a newly created central urgent care clinic. I communicated with my patients through phone calls, computer messages, and video visits. I waited to get redeployed to the front line.

The following Saturday morning, sunlight from the uncertain outside world fell through the window in stripes across my hands. I knelt next to a plastic bin filled with fabrics that my mother had gathered over the decades. Bolts of wool patterned with scrolling vines. Pieces of cotton cloths from her 1987 trip to Kenya with a group of fellow potters. Glittering scraps of silk and sequins. I pulled out my sewing machine and chose the blue-dotted cotton cloth. I carefully measured each side and cut out pairs of rectangles. I pleated the fabric and heated my iron to press it down. I sewed twice around the edges and cut the thread. Another mask.

During the last months of her life, after lung cancer had begun to wreck her body, my mother developed a high fever, a cough, and shortness of breath. This was in a time before Covid, but my mother’s diagnosis of influenza evoked a similar response and treatment plan: admitted to the hospital, she was marked for isolation, surrounded by gowned and masked strangers. She felt ambushed, and when she made it out, my mother told us she never wanted to go back to the hospital.

All around me are the things she made. Square white plates with gray circles stamped in the corner. Wall pieces of flowers and abstract shapes. Generous bowls with delicate rims. Mostly, now, that is how I remember her — piecing together a quilt for my wedding chuppah, pounding clay for my daughters to shape, carefully cooking the dishes she knew we liked. And mostly I have stopped remembering the horror of her last months as cancer ate away at her bones and she screamed at a touch. And her anger at being hospitalized. And the many ways in which medical care failed her.

I think about the lessons my mother taught me. I tie the blue-dotted mask behind my head and exhale slowly, adjusting the edge around my chin. Stoicism and doing what needs to be done. Making things yourself and not wasting them. And as I consider the aftermath of that hospitalization, I think that maybe I never should have told her to go to the emergency department. I wonder about all the patients now gasping for breath alone in their hospital rooms, seeing only gloves and gowns and masks and face shields, kept away from their families. I see the long roads that each of them will face, even those who survive and recover from their infection.

As we make it through month after month of this pandemic, we are starting to consider what recovery will look like. How can we mitigate the trauma of Covid-19 and its treatment for our patients? I consider how even 10 years after her death, my mother’s suffering makes me more empathic — and also helps steady me from the pain of that empathy. Plotting the way forward feels like finding the right materials, tracing out a pattern, carefully pressing down the pedal on the sewing machine. As my colleague Nomi Levy-Carrick wrote, moving forward with resilience depends on our being able to name what is distressing as it happens, share our worries with others, and maintain a sense of purpose.¹

As I negotiate the challenges of patient care in this epidemic, I am grateful for the strengths-oriented approach of trauma-informed care,² with its explicit naming of the importance of both physical and psychological safety. I wonder: If I linger in this conversation, or if I adjust the height of my desk chair and then unthinkingly touch my forehead, will I bring the virus home to my family? When a patient discloses a harrowing experience and my expression is hidden behind a mask while I maintain 6 feet of distance, what can I do to help the patient feel safe? I wonder about safety even on video visits: If I suggest coming into the office for x-rays, am I putting the patient in harm’s way?

Crucially, I have been wondering about how to find meaning and the possibility of growth even as I have floundered in the piles of my patients’ needs and my own uncertainties. In the months that have passed since I struggled to make the right decisions on call, my level of fear has eased — but I have witnessed the toll that has been taken on my patients, my family, myself. I believe that our recovery from the devastation of Covid-9 depends on finding the resilience in our patients and in each other. I take a couple of breaths, feeling the warmth of the fabric against my lips, and head outside to face the day.